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Your Oral Health

Detecting Oral Cancer: A Guide for Healthcare Professionals

Incidence and Survival

Oral or pharyngeal cancer will be diagnosed in an estimated 34,000 Americans this year, and will cause approximately 8,000 deaths. On average, only 50 percent of those with the disease will survive more than five years.
 


The Importance of Early Detection


Early Detection Saves Lives

With early detection and timely treatment, deaths from oral cancer could be dramatically reduced.

The five-year survival rate for those with localized disease at diagnosis is 81 percent compared with only 30 percent for those whose cancer has spread to other parts of the body.

Early detection of oral cancer is often possible. Tissue changes in the mouth that might signal the beginnings of cancer often can be seen and felt easily.


Warning Signs


Lesions that might signal oral cancer

Two lesions that could be precursors to cancer are leukoplakia (white lesions) and erythroplakia (red lesions). Although less common than leukoplakia, erythroplakia and lesions with erythroplakic components have a much greater potential for becoming cancerous. Any white or red lesion that does not resolve itself in two weeks should be reevaluated and considered for biopsy to obtain a definitive diagnosis.


Other Possible Signs and Symptoms

Possible signs and symptoms of oral cancer that may be reported include:
  • a lump or thickening in the oral soft tissues
  • soreness or a feeling that something is caught in the throat
  • difficulty chewing or swallowing
  • ear pain
  • difficulty moving the jaw or tongue
  • hoarseness
  • numbness of the tongue or other areas of the mouth
  • swelling of the jaw that causes dentures to fit poorly or become uncomfortable

If these problems persist for more than two weeks, a thorough clinical examination and laboratory tests, as necessary, should be performed to obtain a definitive diagnosis. If a diagnosis cannot be obtained, referral to the appropriate specialist is indicated.
 


Risk Factors


Tobacco and Alcohol Use

Tobacco and excessive alcohol use increases the risk of oral cancer. Using both tobacco and alcohol poses a much greater risk than using either substance alone.


Sunlight

Exposure to sunlight is a risk factor for lip cancer.


Age

Oral cancer is typically a disease of older people, usually because of their longer exposure to risk factors. Incidence of oral cancer rises steadily with age, reaching a peak in persons ages 65 to 74. For African Americans, incidence peaks about 10 years earlier.


Gender

Oral cancer strikes men twice as often as it does women.


What You Can Do


A thorough head and neck examination should be a routine part of each patient's dental visit and general medical examination. Clinicians should be particularly vigilant in checking those who use tobacco or excessive amounts of alcohol.

The Exam

This exam is abstracted from the standardized oral examination method recommended by the World Health Organization. The method is consistent with those followed by the Centers for Disease Control and Prevention and the National Institutes of Health. It requires adequate lighting, a dental mouth mirror, two 2" x 2" gauze squares, and gloves; it should take no longer than 5 minutes.

The Exam Review

The examination is conducted with the patient seated. Any intraoral prostheses are removed before starting. The extraoral and perioral tissues are examined first, followed by the intraoral tissues.

I. The Extraoral Examination

Face: The extraoral assessment includes inspection of the face, head, and neck. The face, head, and neck are observed, noting any asymmetry or changes on the skin such as crusts, fissuring, growths, or color change. The regional lymph node areas are bilaterally palpated to detect any enlarged nodes. If enlargement is detected, the examiner should determine the mobility and consistency of the nodes. A recommended order of examination includes the preauricular, submandibular, anterior cervical, posterior auricular, and posterior cervical regions.


II. Perioral and Intraoral Soft Tissue Examination


The perioral and intraoral examination procedure follows a seven-step systematic assessment of the lips; labial mucosa and sulcus; commissures, buccal mucosa, and sulcus; gingiva and alveolar ridge; tongue; floor of the mouth; and hard and soft palate.

Lips: Begin examination by observing the lips with the patient's mouth both closed and open. Note the color, texture, and any surface abnormalities of the upper and lower vermilion borders.